I read an article in The New York Times the other day that got me wondering about what accounts for the differences in women who were told they couldn't be X and those of us who never knew they couldn't. In the article, several women share their stories about gender barriers they faced. Often they were dissuaded from pursuing traditionally male careers and were essentially told not to live up to their potential.

What was behind this, I wondered. At first I thought it might be generational --- a consequence of age. But there were women who felt free to pursue their passions even in the early 70s, while young women in school today (!) encountered gender hurdles.

As I read, I thought back on my own upbringing --- my childhood and school years. I can honestly say that it never occurred to me that I couldn't do something simply because of my gender. In fact, academically I never knew I was a girl. My limitations were purely the ones that I put in place for myself.

My mother was a teacher and my father was an engineer. They had the same expectations for me, my brother and my sister --- there is always room for improvement and you should strive for that. I took advanced classes and generally did very well in primary school. I was smart. Period.

I think my father was pretty disappointed when I chose to major in journalism in college. He was convinced that I had much greater potential and journalism was a waste of it. Period. Me, I was good at writing and liked the romantic idealism that I associated with newspapers. I also thought that math, science and engineering were too hard to bother with.

When I chose to go back to school to pursue a chemistry degree, my dad didn't try to conceal his delight. And he always knew I could do it. There were times --- struggling with Fourier transforms and Wheatstone bridges at the kitchen table --- when I really thought that I couldn't. But I believed that was because of some inherent flaw in me as an individual, some quirk of genetics. It never occurred to me that my gender could theoretically enter into the equation.

My dad was right of course. I was able to do it and graduated magna cum laude with a degree in chemistry. My sister is an electrical engineer and my brother graduated with a degree in computer science. We each chose our paths because of our interests, not because of gender.

Looking back, I can now see what should have been awkward moments in the lab when I was the only girl in class --- when conversation turned to how hot 7 of 9 was (that's a Star Trek reference, if you don't know). I never noticed. If I thought about it at all, I suppose I chalked it up to different people liking to talk about different things. I didn't care about the looks of a sci-fi character but I was all over Cam Neely's performance on the ice the night before, scoring a hat trick.

Make that the state of Minnesota. The headline "Questions Can Trigger ‘Split Visit’ Charge At Doc’s Office" recently popped up on the website of the Minnesota CBS affiliate. It seems that a patient was charged for an extra physician visit for asking too many questions. Park Nicollet Health Services told the reporter:

"Medical services are carefully coded for insurance purposes. As Park Nicollet explained to us, the billing has to accurately reflect the medical services provided. If the doctors feel their work goes beyond the scope of the visit, they must code that on the bill. That’s to assure that coverage for a “wellness” visit doesn’t fraudulently cover care given to an “acute care” matter."

This highlights two fundamental problems with health care, in my mind. We all know that primary care physicians already have too much to accomplish in one visit. Visits have to be short though, in order to see more patients (we'll leave out any financial implications).

However, I think many would agree that an educated and engaged patient can be appreciated by most physicians. In an ideal world, physicians would be able to address each of their patient's concerns and answer patient questions.

Unfortunately we live in this country. Should physicians be able to code patient counseling or phone "visits"? Yes. Should insurance companies be able to take advantage of what should be routine care? With physicians not seeing a nickel of the additional charge? Why do we even have to ask that question? In a written statement (reported by the CBS affiliate):

"In a written statement, the medical provider saidthat 'the insurance company may requirethat patients pay or make a co-pay for services beyond the ‘preventive’ part of the appointment.'”The statement goes on to say that the total amount billed to the insurance provider is the same as if it were one appointment, only it’s 'broken out separately on the invoice.'"

The Daily Kos called the new policy bullshit. I can't say that I disagree. They spell it out better than I. "You see, asking a question about an actual problem means your annual physical has been turned into a different kind of visit -- one that is not 'free' from deductibles or cost-sharing payments under Affordable Care Act rules as is the case with physicals and other preventive care like immunizations."

I see this instance opening a door for door for eager insurance companies. The question is: what can we do about it?

Raise your hand if you’ve never seen a pink ribbon or don’t know what it means. No one? The tremendous success of the pink ribbon breast cancer awareness campaign is a great fundraising and awareness lesson for any charitable organization. There are no clear numbers on research funds raised by pink ribbons, in part because there are so many sources for pink ribbon items. Still, those ribbons and the public awareness they’ve raised have made a huge difference in breast cancer research and survival. For example, the 5-year breast cancer relative survival rate in 1975-1977 was 75%. In the most recent data from the American Cancer Society’sCancer Statistics 2011 (table 12),the 5-year breast cancer relative survival rate in 1999-2006 was 90%.According to theNCI Snapshot of Breast Cancer: “In the United States, breast cancer is the most common non-skin cancer and the second-leading cause of cancer-related death in women. Each year, a small number of men are also diagnosed with or die from breast cancer. Although the rate of diagnosis of breast cancer increased in the 1990s, it has decreased since 2000, and the overall breast cancer death rate has dropped steadily.” In 2008, the incidence rate for breast cancer in white women and African American women is just a tad less than 130 breast cancers per 100,000 women in each group. The point is this: we’re had incredible success in raising money, awareness and survival for breast cancer. Maybe it’s time to put the same effort into defeating other cancers. For example, the 5-year relative survival rate for lung/bronchus cancer — represented by a white ribbon, by the way — in 1975-1977 was 13%; in 1999-2006 that rate had increased only to 16%. Worse still: the 5-year relative survival rate for pancreatic cancer (purple ribbon) in 1975-1977 was 3%; in 1999-2006 that rate was 6%. According to theNCI Snapshot of Lung Cancer, lung cancer is the second most common cancer and is the primary cause of cancer-related death in both men and women in the United States. The overall mortality rate for lung and bronchus cancers rose steadily through the 1980s and peaked around 1993. Mortality rates are highest among African-American males, followed by white males.

In 2008, the incidence rate of lung cancer among African American men was roughly 100 per 100,000 men; for white men the rate was about 70 per 100,000 men. Remember though that the 5-year relative lung cancer survival rate in 2006 was estimated at 16%. That’s a lot of people dying…and that’s just lung cancer. By the way November is the awareness month for lung cancer and stomach cancer (periwinkle ribbon). The point is, maybe it’s time that the White Ribbon (or purple or gray or … ) became the new Pink Ribbon.Special thanks to David Sampson, director of medical & scientific communications for the American Cancer Society, for his help with data.